Injury Line: Two Harbors Enterprises
| Inspection Nr | 300760915 |
| Investigation Nr | 201033768 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Other |
| Part of Body | Back |
| Source of Injury | Motor Vehicle(Indus) |
| Event Type | Struck By |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Painters, construction and maintenance |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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